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Preston Kung, Winston Kung, Andrew Caglieris, Shou En Lu, John Kung; Changes To Corneal Endothelial Cell Density After Phacoemulsification Using Different Viscoelastics. Invest. Ophthalmol. Vis. Sci. 2011;52(14):6450.
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© ARVO (1962-2015); The Authors (2016-present)
Phacoemulsification of cataracts is the most common surgery performed worldwide. Corneal endothelial cells are lost due to ultrasound energy. These effects are mitigated by viscoelastics injected into the anterior chamber prior to the introduction of ultrasound energy. The purpose of this study is to compare the effects of various viscoelastics on the corneal endothelial cell density after cataract extraction by phacoemulsification.
Sixty-three (63) eyes/patients were randomized to receive four different viscoelastics: (1) Viscoat (4% chondroitin sulfate/3% sodium hyaluronate), (2) Duovisc (4% chondroitin sulfate/3% sodium hyaluronate and 1% sodium hyaluronate), (3) Amvisc Plus (1.6% sodium hyaluronate) and (4) Provisc (1% sodium hyaluronate). The surgery was performed by the same surgeon, using the same technique. Ultrasound time was recorded and found to be a negligible difference between the cases. Corneal endothelial specular microscopy was performed using the Konan specular microscope. Cell density was recorded for patients preoperatively, post-op day 1, post-op week 2, and post-op week 4. Results were statistically analyzed.
The average age of the patients was 73. Decreased endothelial cell density was observed for each group, at each time interval in the postoperative period compared to preoperative cell density. In the Viscoat group, there was a mean decrease in cell density by 5%; 6% for the Duovisc group; 10% for the Amvisc Plus group; 15% for the Provisc group.
There was the least amount of endothelial cell loss with the first two groups (Viscoat and Duovisc) and the most with the Provisc group. Corneal edema did not directly correlate with corneal endothelial cell loss. Visual acuity also did not correlate with corneal endothelial cell loss. The higher molecular weight viscoelastics protected the cornea best during cataract surgery.
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